What is “Sundowning” & How to Manage

What is Sundowning:

Sundowning is a symptom of Alzheimer’s disease and other forms of dementia.  Not all patients who suffer from dementia or Alzheimer’s exhibit Sundowner symptoms.  It can also be known as “late-day confusion.”   Your clients/loved ones confusion and agitation may get worse in the late afternoon and evening. In comparison, their symptoms may be less pronounced earlier in the day.   Your client or loved one is most likely to experience sundowning if they have mid-stage to advanced dementia. Sundowning  Syndrome remains a mystery to medical science.  More and more studies are being conducted to try and determining the exact cause.

Living with Sundowner’s:  You must pay attention to behavior patterns. It may help to keep a diary of activities and behaviors during the day and evening in order to determine if the behavior occurs after a specific event or activity. Don’t forget to documenting things on your time sheets as well. You may have to avoid visitors, children, and certain activities to prevent symptoms, or you may have to restrict certain foods that might appear to be causing symptoms.  Even adjusting the lighting in the home could help reduce their symptoms too.  Also let the office as well as your clients doctor know of any changes and concerns you might have.

How to Manage “Sundowning”

First off is educate yourself so you are more apt to help your client.  Think about adapting their environment to them, as opposed to trying to get them to adapt to their environment.

You can take steps to help manage through out the day.  Too much daytime dozing and inactivity can make it harder for your loved one to fall asleep at bedtime. To promote a good night’s sleep, help them stay active during the day.   Adjusting your clients/loved one’s eating patterns may also help reduce their sundowning symptoms.  Larger meals can increase their agitation and may even keep them up at night, especially if they consume caffeine &/or sugar. Encourage your client/loved one to avoid those substances or enjoy them earlier in the day rather than dinner. Limiting their evening food intake to a hearty snack or light meal might help them feel more comfortable and rest easier at night.

Try to help your client/ loved one stay calm in the evening hours. Encourage them to stick to simple activities that aren’t too challenging or frightening. Frustration and stress can add to their confusion and irritability.   Try to stick to some sort of a routine with your clients/loved ones.         If they have mid-stage or advanced dementia, watching television or reading a book might be too difficult for them. Instead, consider playing soft music to create a calm and quiet environment or the nature sounds or waves.   Communicate with short sentences and speak slowly—their brain is damaged and may need extra time to process. Don’t speak loudly unless they also have a hearing problem.


When someone is sundowning, they may be:

  • Agitated (upset or anxious)
  • Restless
  • Irritable
  • Confused
  • Disoriented
  • Demanding
  • Suspicious

They also may:

  • Yell
  • Pace
  • Hear or see things that aren’t there
  • Have mood swings

Up to 1 out of 5 people with Alzheimer’s get sundown syndrome. But it can also happen to older people who don’t have dementia.